Abstract
Bevacizumab uses Bevacizumab (Avastin®, Genethech, Inc.) is a humanized monoclonal antibody that inhibits vascular endothelial growth factor (VEGF). It was first approved by the US food and drug administration for metastatic colorectal cancer and subsequently for cervical/ovarian/fallopian tube cancers, glioblastoma, non-small cell lung cancer, and metastaic renal cell carcinoma [1]. Recently its offlabel use for age-related macular degeneration (AMD) has received extensive attention. Single dose vial of intravitreal ranibizumab (IVR), another anti-VEGF antibody, has been licensed for treatment of wet AMD and diabetic macular edema [1,2]. Due to lower cost and reported equall efficacy and safety data in large clinicat trials such as The Comparison of Age-related Macular Degeneration Treatment Trial (CATT), The Inhibitors of VEGF in Age-related Choroidal Neovascularization (IVAN) and GEFAL studies, intravitreal bevacizumab (IVB) has replaced the intravitreal administration of the approved drug ranibizumab [2-7]. A recent review on IVB administration for management of AMD and pathological myopathy concluded that despite promising results, short-term patients’ follow-up in the available studies, lack of well-designed extensive clinical trials, and insufficient data on safety of IVB make its use cautiously in these ocular diseases [8]. IVB administration has been widely used in other different proliferative retinopathies including retinopathy of prematurity [9,10] and diabetic retinopathy [9,11] as well. Angiogenesis with key regulator VEGF is the main pathology in these retinal and choroidal diseases [9]. A review on IVB administration for treatment of different aforementioned retinal and choroidal diseases showed promising reults [12].
Highlights
Bevacizumab uses Bevacizumab (Avastin®, Genethech, Inc.) is a humanized monoclonal antibody that inhibits vascular endothelial growth factor (VEGF)
Post-injection complications that are not influenced by the underlying ocular disease include infectious endophthalmitis, sterile intraocular inflammation, rhegmatogenous retinal detachment, increased intraocular pressure and ocular hemorrhage
Drug-related dverse events which are influenced by underlying ocular disease include development or progression of tractional retinal detachment when intravitreal bevacizumab (IVB) administration done before vitrectomy in patients with advanced proliferative diabetic retinopathy, possible increase in the incidence of retinal pigment epithelium tears in patients with age-related macular degeneration (AMD) and worsening retinal detachment in patients with severe retinopathy of prematurity [9,12]
Summary
Bevacizumab uses Bevacizumab (Avastin®, Genethech, Inc.) is a humanized monoclonal antibody that inhibits vascular endothelial growth factor (VEGF). Preservative free vials of bevacizumab have not been created for intravitreal administration.A recent systematic review with aim of evaluating the safety of IVB monotherapy in adult ophthalmic conditions assessed 22 controlled trials and 67 observational studies that contained at least 10 patients showed no difference in the rate of endophthalmitis between the two groups of patients receiving off-labeled IVB or licensed IVR [13]. There are several methods for preparing IVB including multiple withdrawal from the same vial within the same day or at different days under aseptic conditions by ophthalmologist or preparing single use syringes of IVB injection from bevacizumab vials by a compounding pharmacy or a pharmaceutical company.
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